KELLY ANN CLARK

BETHANY, MO
NPI1164062972
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: MO  2020000768)
Additional Taxonomies207Q00000X Family Medicine
(Licence: MO  2020000768)
Enumeration Date2020-01-09
Last Update Date2021-03-18
Business Address
KELLY ANN CLARK
3202 MILLER ST
BETHANY, MO 64424-2713
Phone number: 660-425-3154
Mailing Address
KELLY ANN CLARK
3202 MILLER ST
BETHANY, MO 64424-2713
Phone number: 660-425-3154